Psychiatric morbidity following endometrial ablation and its association with genuine menorrhagia

Barry Wright, Michael Gannon, Maurice Greenberg, Allan House, Tony Rutherford
In: BJOG: An International Journal of Obstetrics & Gynaecology · 2003 · vol. 110(4) , pp. 358–363 · doi:10.1046/j.1471-0528.2003.02199.x · PMID:12699796 · W1977655337
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This prospective study found that women with genuine heavy menstrual bleeding and low pre-operative psychiatric morbidity had the best outcomes after endometrial ablation, while those with high pre-operative psychiatric morbidity and low blood loss fared worst.

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Abstract

OBJECTIVE: To explore the relation between pre-operative psychiatric morbidity, menstrual blood loss and psychiatric outcome in women receiving endometrial ablation for heavy periods. DESIGN: A prospective cohort study. SETTING: The menorrhagia clinic at Leeds General Infirmary. POPULATION: One hundred and twenty consecutive women referred to the Clinic for endometrial ablation. METHODS: Psychiatric interview and actual menstrual blood loss measurements at presentation pre-operatively and one year post endometrial ablation. MAIN OUTCOME MEASURE: Psychiatric status using the semi-structured interview, Present State Examination, with measurement of menstrual blood loss. RESULTS: Endometrial ablation was performed on 92 women. Of the 87 women evaluated 51 (59%) had clinically significant psychiatric symptoms, mainly depression and anxiety. Psychiatric morbidity fell to 21.8% at one year after endometrial ablation. Women with the best psychiatric outcome (6% post-operative psychiatric morbidity) were those with genuine menorrhagia (> or =80 mL) and low psychiatric morbidity pre-operatively. Those who fared worst (39% post-operative psychiatric morbidity) were women with high pre-operative psychiatric morbidity and low menstrual blood loss. Of seven women with very low losses [mean 19 mL (SD 17)] who did not proceed to surgery after counselling, six (86%) had significant psychiatric morbidity. CONCLUSIONS: Pre-operative psychiatric status and menstrual blood loss are predictors of outcome of surgery for women with reported heavy periods.

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